Associations between actual and perceived weight and psychosocial functioning in children: the importance of child perceptions

Inconsistent relationships between weight and psychosocial functioning may be due to discrepancies between objective measures of weight and children's perceptions of weight. The current study compared the predictive validity of actual versus perceived weight in children to determine which is the strongest predictor of psychosocial functioning. Ninety-eight youth (ages 8-17) completed measures of perceived weight and psychosocial functioning (i.e., depressive symptoms, peer victimization, and self-esteem) while attending a well-child visit. Height and weight were obtained from the medical record and used to classify children as healthy weight, overweight, or obese. Actual and perceived weight percentiles were entered simultaneously in regression analyses predicting psychosocial functioning. A disproportionate number of overweight (70%) and obese (40.6%) youth reported a perceived weight in the healthy range (below 85(th) BMI percentile). Perceived weight was predictive of depressive symptoms whereas actual weight was not. No relationship between weight (perceived or actual) was found for peer victimization or self-esteem. Weight underestimation is common in children, particularly among youth who are overweight and obese. Perceived, but not actual, weight was predictive of depressive symptoms, highlighting the importance of weight perceptions among youth across the weight spectrum.